Inflamm Bowel Dis. 2024 Sep 3;30(9):1475-1481.doi: 10.1093/ibd/izad199.

Massimo Martinelli ¹, Erminia Romeo ², Tamara Caldaro ², Konstantina Dimakou ³, Alexandra Papadopoulou ³, Manar Matar ⁴, Amit Assa ⁵, Valeria Dipasquale ⁶, Claudio Romano ⁶, Marina Aloi ⁷, Patrizia Alvisi ⁸, Dennis Röser ⁹, Kaija Leena Kolho ¹⁰, Nadeem Afzal ^11 12, Oren Ledder ⁵, Schlomi Cohen ¹³, Jiri Bronsky ¹⁴, Johanna C Escher ¹⁵, Annecarin Brueckner ¹⁶, Raanan Shamir ⁴, Annamaria Staiano ¹, Erasmo Miele ¹

Author information

¹Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.

²Digestive Endoscopy and Surgery Unit, Bambino Gesu Children's Hospital-IRCCS, Rome, Italy.

³Division of Gastroenterology and Hepatology, First Department of Pediatrics, Children's Hospital Agia Sofia, University of Athens, Athens, Greece.

⁴Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tikva, Israel.

⁵Juliet Keidan institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel.

⁶Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy.

⁷Pediatric Gastroenterology Unit, Department of Women's and Children's Health, Sapienza University, Rome, Italy.

⁸Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy.

⁹Department of Paediatrics, Hvidovre University Hospital, Copenhagen, Denmark.

¹⁰Children's Hospital, University of Helsinki and HUS Helsinki, Finland.

¹¹Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, United Kingdom.

¹²University of Portsmouth, Portsmouth, United Kingdom.

¹³Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

¹⁴Department of Paediatrics, University Hospital Motol, Prague, Czech Republic.

¹⁵Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.

¹⁶Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, Ludwig Maximilians University, Munich, Germany.

Abstract

Background and aims: We sought to define the prevalence and to characterize possible predictive factors of Crohn's disease (CD) occurring in children with ulcerative colitis (UC) after ileal pouch-anal anastomosis (IPAA).

Methods: This was a multicenter, retrospective study including 15 centers of the Porto IBD group of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Children with a confirmed diagnosis of UC undergoing colectomy with IPAA and a minimal follow up of 6 months were identified. The following data were collected: demographic data; endoscopic and histologic data; disease activity; laboratory exams; therapeutic history; indication for surgery, type, and timing; and IPAA functional outcomes and complications. In de novo CD cases, time of diagnosis, phenotype, location, and therapies were gathered.

Results: We identified 111 UC children undergoing IPAA from January 2008 to June 2018 (median age at colectomy: 13 years; age range: 1-18 years; female/male: 59/52). The median time from diagnosis to colectomy was 16 (range, 0-202) months. At the last follow-up, 40 (36%) of 111 children developed pouchitis. The criteria for de novo CD were met in 19(17.1%) of 111 children with a 25-month median (range, 3-61 months). At last follow-up, 12 (63.1%) of 19 were treated with biologics and in 5 (26.3%) of 19 children, the pouch was replaced with definitive ileostomy. In a multivariable logistic regression model, decreased preoperative body mass index z scores (odds ratio, 2.2; 95% confidence interval, 1.1-4.4; P = .01) resulted as the only variable associated with CD development.

Conclusions: Children with UC undergoing IPAA carry a high risk of developing subsequent CD. De novo CD cases showed decreased preoperative body mass index z scores, identifying a poor nutritional status as a possible predictive factor.